FAMILIESUSA.ORG

Equity in COVID-19 Vaccines: Emerging Lessons from the Front Lines

As of March 2021, the United States is administering more than 3 million COVID-19 vaccines a day.1 From the day vaccines were on the horizon, Congress,2 governors,3 and the Biden administration4 committed to equitably distributing them, pointing to disproportionately high rates of COVID-19-related illness and death among Black, Indigenous, and people of color (BIPOC). These disparate outcomes from COVID-19 are linked to longstanding inequities in health care and systemic racism within society.5

Accomplishing equitable distribution, however, It is essential for policy makers and the public to generally has not been achieved.6 In ramping up understand that BIPOC are bearing the brunt of this vaccine distribution quickly, state leaders report trying pandemic, both in terms of their health and their financial to balance low supply and high demand while also wellbeing. Since the pandemic began, BIPOC have been navigating competing demands for prioritization. One disproportionately more likely to become infected, to be concerning choice was the conscious decision by some hospitalized, and to die compared to their percentage of state leaders to move toward strategies based on age the population.11 For example, data from Rhode Island (as Connecticut and Maine did)7 and away from equity- indicate that Black and Latino individuals ages 35-44 based strategies that focus on essential workers,8 who are three times more likely to be hospitalized from are disproportionately more likely to be BIPOC.9 And than older White individuals ages 74-85 (see page 2). even as supplies have increased, the pattern across And now, they are not being given access to vaccinations virtually every states is consistent: Black and Hispanic in ways that are proportionate to either their share of the people continue to get fewer vaccine shares relative to population or their risk of illness and death. Moreover, the the COVID-19 death and illness they experience.10

April 2021 Issue Brief FAMILIESUSA.ORG

Rhode Island Department of Health

Source: Rhode Island Department of Health (RIDH), Age-adjusted rates of COVID-19 hospitalizations by age group & race/ethnicity. Sources: RIDOH, Hospital Incident Reporting System data; RIDOH, SalesForce COVID-19 case investigation data; US Census Bureau, 2018 American Community Survey 5-year estimates; CDC age adjustment weights

pandemic is not just a health, but also an economic crisis be at the center of today’s response and future efforts to for BIPOC. Because these communities are more likely build resilience, prepare for the next public health crisis, to have front-line jobs (placing them at much higher risk and create a more equitable health system overall. of increased exposure), they are less likely to be able to To this end, Families USA has developed a roadmap work from home. As a result, their jobs often force them of promising approaches for equitable distribution to choose between prioritizing their economic livelihood of vaccines in the short term, based on input from and their health.12 Thus, a vaccination strategy that is state and local partners. The roadmap synthesizes fundamentally aimed at reducing death and illness early lessons and provides key insights and concrete from COVID-19 must intentionally focus on effective approaches that state partners and leaders can use vaccination of BIPOC populations. moving forward.

We are at a critical moment for ensuring health care This roadmap is the first in a series of publications equity and correcting the fundamental disparities that and other work that Families USA will undertake the pandemic has laid bare. Intentional investments in with partner organizations to ensure the equitable equitable distribution of the vaccines — and equitable distribution of COVID-19 vaccines. Further research, public health strategies designed to end the pandemic including roundtables, focus groups, and support of — have the potential to establish a course-correction a consumer advocate learning network, is underway. on which we can build long-lasting structural change. Please connect with us at Familiesusa.org for updates Focusing on the experiences and needs of BIPOC must on this work.

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Roadmap for the Equitable Distribution of COVID-19 Vaccines

Overarching Principle: A vaccination strategy that aims to reduce death and illness from COVID-19 must intentionally focus on effective vaccination of communities of color.

USE A DATA-DRIVEN APPROACH » COVID 19 Community Vulnerability Index (CCVI)16 To develop policies for allocating vaccines in » CDC’s Social Vulnerability Index (SVI)17 an equitable manner, gather data to determine 18 who is most likely to contract COVID-19 and to » Area Deprivation Index (ADI) experience negative consequences such as death » Map: County-Level Access for Black and White and hospitalization. National, state, and local Individuals to Potential COVID-19 Vaccine 13, 14 dashboards that track cases, hospitalizations, Administration Facilities,†, 19 and vaccine allocation disaggregated by race, ethnicity, and other demographics are an important Importantly, while these indices are a helpful foundation for this type of data. However, there has barometer for a data-driven approach, they are been inconsistent and incomplete data and reporting incomplete and require local input to increase on race and ethnicity at the local, state and national success. For example, the Social Vulnerability Index levels on testing, cases, hospitalizations, deaths and (SVI), like the U.S. Census, leaves out Middle Eastern 20 now vaccines.15 To get more granular, states and and North African populations, and even when data localities are employing other assessment tools to does take into account race and ethnicity, there is still inform equitable approaches and ascertaining which heterogeneity within communities that is important to 21 communities might need additional resources and understand. In order to effectively tailor responses support to maximize vaccine uptake. Governmental to specific communities, state leaders need to officials and public health experts should consider supplement assessment tools with qualitative data via the following examples as part of an equitable direct input from key community stakeholders. vaccine distribution strategy:

Spotlight on Protect Chicago Plus

Protect Chicago Plus, an initiative of Mayor Lightfoot, used SVI data to prioritize 15 high- need communities “to ensure that a significant part of the City’s vaccine supply goes to these communities.”

† Geomapping such as this example from the University of Pittsburgh School of Pharmacy and West Health can help state leaders understand where vaccination sites should be located and how far individuals have to travel to access services.

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CONNECT WITH THE COMMUNITY AND PROVIDE RESOURCES Spotlight on Community-Based Vaccinations: A Tale of Three Communities When things are moving quickly — as they are In Fort Worth, TX in the world of COVID-19 vaccine distribution — understanding the local context is key. In particular, some community leaders are organizing to distribute Community A: Hispanic Population the vaccines and engage their neighbors to increase » Community groups worked with an engaged uptake while simultaneously providing contours to and enthusiastic councilmember who a successful public health approach in their own helped to drive the vaccine event including community. Locally-organized efforts led by trusted using social media channels. pillars of the community can be essential to success. Community members were able to get their State and local public health partners should identify, » vaccines and talk with the councilmember learn from them, address barriers and provide them about other issues in their community. resources to execute vaccination initiatives. » Event was held at the local community When figuring out how to scale vaccine efforts center. state leaders can identify and encourage effective 335 people were vaccinated. approaches by hosting community listening sessions » and by emulating successful case studies from within their own state and around the country. One example Community B: Hispanic and Black Population from Philadelphia highlights the local partnerships between medical centers and African American » Community groups were not engaged in the churches that helped vaccinate 5,000 Black residents vaccine clinic. in one day.22 Another example from Fort Worth, Texas, » No local officials attended, and turnout was provides a “tale of three communities,” (see sidebar) low. highlighting the importance of having a local champion with authority and community reach, authentic » Event was held at a local fire station. engagement and connecting in trusted spaces.23 » 39 people were vaccinated.

A few key elements that lead to success include:

» Ensuring that community leaders participate Community C: Black Population routinely in advising city and state officials » Event led by a local church congregation. about allocation strategies and events. One » Church leaders attended and promoted the way this can be accomplished is by working with event heavily. community leaders to host listening sessions that are open to the entire community. These » Event was held at the church. sessions should also include local leaders, trusted » 757 people were vaccinated.

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health care professionals, and other influential managing expectations of non-community stakeholders (for example, business leaders or members who seek vaccination. To protect lives faith leaders) who are members of the community in an environment of vaccine scarcity, vaccination and who can advocate on its behalf. Local leaders strategies must prioritize communities with the representative of BIPOC communities should be highest need and others who are vulnerable. engaged in advisory groups and task forces. Some successful strategies involve organizing community members and sharing specific » Asking community members what they registration codes with them, or establishing need from the public health response and sign-up lists. Success with these approaches has being prepared to meet those needs. People varied, and other approaches are needed even as implementing vaccine efforts must be open to vaccine supply increases. Setting up phone banks engaging authentically with communities and has been helpful in addressing the limitations addressing the range of issues they identify. of online registration systems, and it is central For example, these needs could include access to an approach that takes into account limited to transportation, language services, personal internet access. Phone banks may also be useful protective equipment (PPE) and timing of in focusing resources on specific communities. vaccine allocations. This ground work will help to maximize uptake and confidence, and it can Vaccines are also flowing directly from the federal contribute to a comprehensive approach that government to local communities, some of addresses longstanding inequities. which specifically focus on distribution to at-risk communities. For example, the Health Center COVID-19 » Leveraging partnerships with community- Vaccine Program26 is prioritizing health centers serving based organizations to achieve common people hardest hit by the pandemic including people goals that address community needs. For experiencing homelessness, residents of public example, the Faith in Vaccines initiative in housing, migrants, seasonal agricultural workers, Washington, D.C., includes a federally qualified or patients with limited English proficiency, among health center where vaccines are stored, area others. Other examples of federal to local efforts churches, and an organization that administers include those from the Department of Veterans Affairs shots and provides mobile units.24 Another (VA)27 and the Indian Health Service (IHS).28 State example of nontraditional public health partners note that these federal to local efforts have partnerships involves Emergency Management been some of the most successful collaborations to Services (EMS) helping staff vaccine events or date in terms of getting shots into arms in an equitable vaccinating people who are homebound.25 manner. Additionally, in rural areas, partners have » Ensuring that people who get vaccinated are found that independent pharmacies are central to from the communities of highest need, and distribution.

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BRING VACCINES TO SAFE AND WORK WITH THE COMMUNITY TO SIGN FAMILIAR SPACES PEOPLE UP AND PROVIDE A SMOOTH VACCINATION EXPERIENCE By using place-based solutions, leaders can bring vaccines to communities that need them most both As was widely reported in the news, online options for during short supply and as supply increases. These scheduling vaccination appointments have not worked efforts have included hosting a vaccine clinic in a well for many and are exacerbating disparate access to local school gymnasium (Virginia State University),29 vaccines.34, 35, 36 To ensure that individuals from prioritized bringing mobile units into communities (Farmworkers communities are able to make appointments, state and in California),30 coordinating with local tribes (Alaska),31 local leaders should consider other strategies for signing and providing needed transportation while ensuring that people up, such as using texts, toll-free phone numbers, people who need it can be vaccinated in their homes and door knocking, as well as enlisting the help of local (Baltimore County).32 Local and state leaders need to be business leaders and other community health champions flexible and creative with vaccine dissemination. (including community health workers and promotoras). It is also important to make available translation and In addition to vaccinating people at easily accessible, interpretation services, and written resources in multiple familiar locations, states should ensure that vaccines languages (where indicated), to help people throughout ∫ are free to everyone regardless of immigration status, the process — from navigating the appointment system that vaccination sites are accessible on weekends to getting the vaccine.37, 38, 39 Walk-in sites are essential in and outside traditional business hours, and that some communities. documentation is not required to be vaccinated. Leaders should also pay close attention to barriers While community-based vaccination sites are essential, faced by specific populations, such as people with transportation to otherwise inaccessible locations is disabilities, people with limited English proficiency, needed. Some initiatives are starting to fill this gap. For and immigrants. As noted by the National Immigration example, ride hailing providers are collaborating with Law Center, “…[d]ocumentation requirements, data community partners and payers. One example is from sharing fears, discrimination, technology, worries CVS, Lyft and the YMCA who have partnered to provide about their status, and misinformation all are making free or discounted rides to vaccination appointments. it harder for immigrants to get vaccines.”33 Officials Additionally, they are launching their own mobile should eliminate these barriers whenever possible. vaccination vans and community-based vaccination sites starting in March and April 2021.40

By using place-based solutions, leaders can bring vaccines to communities that need them most both during short supply and as supply increases.

∫ The Centers for Disease Control and Prevention has made it clear that vaccines are free for individuals regardless of their immigration or insurance status. 6 FAMILIESUSA.ORG

REMAIN FOCUSED ON EQUITY: HAVE CONTINUE FOCUSING ON EQUITY AS THE POLITICAL WILL TO SAY “NO” VACCINE SUPPLY INCREASES Informed decision-making, coupled with resolute The increasing vaccine supply and the loosening leadership and clear communication, are needed of criteria for vaccine eligibility do not mean that when vaccine supplies are limited. Political leaders the focus on equitable distribution should end. should be transparent about their goals and the Infectious disease expert and former Biden COVID-19 importance of equity-based distribution. A recent advisor, Mike Osterholm recently cautioned: “I am episode of the podcast Tradeoffs,41 echoed repeat very concerned about the number of states that are observations from state partners: Local and state opening up completely all of their vaccine eligibility…I leaders need to review the data, prioritize equity am really concerned about the fact that many of these and stand by those decisions. “I say no 100 times states…actually have vaccine available that should be a day right now to a lot of providers, communities, going to high-risk people in those states that are not individuals, about all things related to vaccine. I have getting vaccinated…[State leaders are] saying ‘let’s just to say no so that we can say yes to these [equity] open it up to everybody knowing that we are missing initiatives,” says Chicago Commissioner of Public high risk people.’43” In fact, state and local leaders will Health Allison Arwady.42 need to continue to ensure that vaccines are getting to communities that need them, quickly, so that The bully pulpit and political will can set the tone infections rates stay low or decrease from the recent and shift the dynamic to prioritizing equity. Officials surge we are seeing in some states.44 may face challenges in this regard, such as the concern that equitable strategies will slow down Reflections on Vaccine Confidence vaccination progress, or that confidence is a major While BIPOC have some concerns and questions barrier for BIPOC (discussed in more detail on page about vaccines due, in part, to the role of institutional 7). Policymakers who are committed to saving lives, racism, almost universally, state partners report that addressing disparities in COVID-19-related outcomes, the demand from BIPOC communities for vaccines far and addressing longstanding inequities in the health outweighs hesitancy to get vaccinated. State partners care system should be empowered to say no to point out that claims of refusal due to historical efforts to pressure them to shift away from equitable atrocities45 are exaggerated in some cases and are responses. The data clearly support this approach. being used as an excuse to provide fewer vaccines Doing so is a public health necessity and tackling real to these communities when supply is low. In fact, or perceived complexity in an equity-based approach data suggest that the groups most likely to refuse the is a vital step in addressing longstanding inequities. vaccine identify as Republican, live in rural areas, and

State partners report that the demand from BIPOC communities for vaccines far outweighs hesitancy to get vaccinated.

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are non-health care essential workers.46 According to Broader Public Health Tools for Ensuring the Kaiser Family Foundation poling, there are varying a More Equitable Response to COVID-19 levels of refusal and rapid progress may be made in With the spotlight on COVID-19 vaccines, it’s important the hesitant or “wait and see” group.47 that state leaders not lose sight of the public health tools that will bolster successful vaccination campaigns Misinformation is another critical piece to vaccine and protect against harmful variants. confidence. A study focused on vaccine acceptance in the U.S. and the U.K. found that exposure to 1. Testing: Testing should be free and accessible, misinformation reduced an individual’s intent especially in the hardest hit communities, to receive a COVID-19 vaccine.48 Anecdotes of such as those identified by the CDC's Social misinformation vary—including a fear from older White Vulnerability Index and through listening people that the vaccine would put a chip in their arm, sessions.50 Diagnostic, antibody, and surveillance to Black college students believing that a healthy testing will all be essential as we move into new lifestyle will protect them from contracting COVID-19. stages of the pandemic. Similarly, contact tracing All of this suggests that public health messaging must and quarantining will remain major elements be tailored to individuals and communities need. of public health response strategies. Some locations are forgoing testing to make way for Strategies to address vaccine confidence must center vaccination sites.51 States need to ensure that on the community that is being engaged, must they make resources available to do both. reflect community concerns with cultural humility, and answering questions with an evidence-informed 2. Public Health Infrastructure: In just a few approach. Public health communicators should also short weeks, vaccine supply has increased and speak to people as informed consumers and avoid vaccination campaigns ramped up.52 States and pre-conceived notions about requests for additional communities need to build the infrastructure information. Actively engaging local leaders and and partnerships, particularly at the community partners (as in the examples above), using data to level, now to handle the coming supply of understand supply and demand, and identifying vaccines. States will also need this community- any health literacy or other barriers are other useful driven infrastructure to achieve the ultimate goal approaches. of herd immunity. According to Anthony Fauci, we will reach herd immunity when 75%-85% of the population has immunity either from a Spotlight on Tailored Communication vaccine or natural infection.53 3. Support services for low-income individuals: The Conversation: Between Us, About Us" Low-income people, especially those in A campaign video series to answer communities hardest hit by the pandemic, will questions about the COVID-19 vaccines continue to need support services such as that “dispels misinformation and financial assistance to quarantine if necessary, provides accessible facts to help Black people with this important decision.”49 in-home services and supports such as food delivery, and continued access to free testing and treatment of COVID-19. 8 FAMILIESUSA.ORG

4. Equitable genomic surveillance: The CDC Conclusion reports that some of the COVID-19 “variants The issue of equitable vaccine distribution may seem of concern” are in fact more transmissible and like a short-term problem that will quickly be fixed as more deadly than the original strains that the the vaccine supply increases. This is a shortsighted U.S. has fought over the past year.54 Leading assumption that doesn’t take into account the vaccine manufacturers are developing booster longstanding racial and economic inequities in this shots to augment immune response in the face country. It also ignores the likelihood of more public of variants, but the impact of the new strains is health crises on the horizon and the critical need to unclear. Moving forward, an equitable national build resilience in these communities. genomic surveillance plan with a representative sample of Americans is a critical component of A mass vaccination campaign built on a health the coronavirus response. Equitable genomic system rife with inequities will likely lead to more surveillance is essential to tracking variants inequities. Underserved and forgotten communities across communities. And it is only with a will continue to be underserved and forgotten unless robust effort to track genetic mutations that political leaders address the underlying causes of this we will be able to understand how and where disenfranchisement. And BIPOC who face health and mutations are happening in the U.S. and around economic barriers will continue to be at greater risk for the world.55 A March 2021 Rockefeller report56 infection, illness, and death. highlights the need for this work so that the Supplies of the vaccine are growing, meaning states country can stay on top of any mutations and need to redouble their commitments to equity and attempt to ward off the devastating health develop distribution plans that respond to community and economic impacts that the country has needs. Through developing responsive distribution experienced over the past year. plans, states can draw on these creative and successful strategies centered on equity to build a more just health care system for the future.

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Endnotes vaccinations-race-ethnicity/. 1 “See How the Vaccine Rollout Is Going in Your County and State,” 11 Centers for Disease Control and Prevention, “Risk for COVID-19 infection, The New York Times, April 5, 2021, https://www.nytimes.com/ Hospitalization, and Death by Race/Ethnicity,” March 12, 2021, https:// interactive/2020/us/covid-19-vaccine-doses.html. www.cdc.gov/coronavirus/2019-ncov/covid-data/investigations- 2 “Vaccine Distribution Is a Racial Justice Issue,” The Official U.S. Senate discovery/hospitalization-death-by-race-ethnicity.html. website of Senator Ed Markey of Massachusetts, February 20, 2021, Rhode Island Department of Health (RIDH), Age-adjusted rates of https://www.markey.senate.gov/view/vaccine-distribution-is-a-racial- COVID-19 hospitalizations by age group & race/ethnicity. Sources: RIDOH, justice-issue. Hospital Incident Reporting System data; RIDOH, SalesForce COVID-19 3 “Governor Sisolak Announces Initiative to Address Equity in COVID-19 case investigation data; US Census Bureau, 2018 American Community Vaccine Distribution in Nevada,” Nevada Governor Steve Sisolak, Survey 5-year estimates; CDC age adjustment weights. February 5, 2021, https://gov.nv.gov/News/Press/2021/Governor_ 12 Catherine Powell, “The Color and Gender of COVID: Essential Workers, Sisolak_announces_initiative_to_address_equity_in_COVID-19_ Not Disposable People,” Think Global Health, June 4, 2020, https://www. vaccine_distribution_in_Nevada/. thinkglobalhealth.org/article/color-and-gender-covid-essential-workers- 4 Fact Sheet: President-Elect Biden Outlines COVID-19 Vaccination Plan, not-disposable-people. and Gina Kolata, “Social Inequities Explain Racial The White House, January 15, 2021, https://www.whitehouse.gov/ Gaps in Pandemic, Studies Find,” The New York Times, December 9, briefing-room/statements-releases/2021/01/15/fact-sheet-president- 2020, https://www.nytimes.com/2020/12/09/health/coronavirus-black- elect-biden-outlines-covid-19-vaccination-plan/. hispanic.html. 13 5 Clarence C Gravlee, “Systemic racism, chronic health inequities, and “COVID-19 Vaccine Summary,” Virginia Department of Health, March COVID-19: A syndemic in the making?” American journal of human 30, 2021, https://www.vdh.virginia.gov/coronavirus/covid-19-vaccine- biology: the official journal of the Human Biology Council 32, August 4, summary/. 2020, https://doi.org/10.1002/ajhb.23482. 14 “COVID19 Vaccine Dashboard,” North Dakota State Government,” 6 Michelle Hughes, Alice Wang, and Marissa Grossman, “County-Level accessed March 30, 2021, https://www.health.nd.gov/covid19vaccine/ COVID-19 Vaccination Coverage and Social Vulnerability — United dashboard. States, December 14, 2020—March 1, 2021,” MMWR. Morbidity and 15 Thoumi A., Tewarson H. & Johnson, K., (2021 March). Prioritizing Equity Mortality Weekly Report 70 (March 6, 2021), https://doi.org/10.15585/ for COVID-19 Vaccinations: Promising Practices from States to Reduce mmwr.mm7012e1. Racial and Ethnic Disparities. Washington, DC: Duke-Margolis Center 7 Brenda Leon, Some States Drop CDC Guidelines And Vaccinate for Health Policy and National Governors Association Center for Best People By Age Group. National Public Radio (NPR), March 3, 2021, Practices. https://www.npr.org/2021/03/03/972973668/some-states-drop-cdc- 16 Surgo Ventures, Precision for COVID, “The U.S. COVID Community guidelines-and-vaccinate-people-by-age-group. Vulnerability Index,” accessed March 31, 2021, https://precisionforcovid. 8 Yea-Hung Chen et al., “Excess Mortality Associated with the COVID-19 org/ccvi. Pandemic among Californians 18—65 Years of Age, by Occupational 17 Centers for Disease Control and Prevention (CDC), Agency for Toxic Sector and Occupation: March through October 2020,” preprint Substances and Disease Registry (ATSDR) ”CDC Social Vulnerability Index,” (Occupational and Environmental Health, January 22, 2021), https:// September 15, 2020, https://www.atsdr.cdc.gov/placeandhealth/svi/ doi.org/10.1101/2021.01.21.21250266. index.html. 9 Tiana Rogers et al., “Racial Disparities in COVID‐19 Mortality 18 Maroko et al., ”Integrating Social Determinants of Health With among Essential Workers in the United States,” World Med Health Treatment and Prevention: A New Tool to Assess Local Area Deprivation.” Policy, August 5, 2020, https://www.ncbi.nlm.nih.gov/pmc/articles/ Preventing Chronic Disease 13, (2016), http://dx.doi.org/10.5888/ PMC7436547/. pcd13.160221external icon. 10 Nambi Ndugga, et. al., “Latest Data on COVID-19 Vaccinations by 19 West Health, “VaxMap 2.0: West Health Policy Center and University of Race/Ethnicity,” Kaiser Family Foundation, March 31, 2021, https:// Pittsburgh School of Pharmacy Develop County-Level Map of Potential www.kff.org/coronavirus-covid-19/issue-brief/latest-data-on-covid-19- COVID-19 Vaccine Locations,” Data Visualizations, accessed March 15,

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2021, https://www.westhealth.org/resource/vaxmap-potential- https://www.nytimes.com/2021/03/01/us/coronavirus-vaccine- covid-19-vaccine-locations/. farmworkers-california.html?searchResultPosition=4. 20 Hansi Lo Wang, “Census Bureau: No Middle Eastern or 31 Chelsea Cirruzzo, “Alaska Leads COVID-19 Vaccination Efforts by North African Check Box,” March 10, 2021, https://www.npr. Coordinating with Tribes and Receiving Territory Vaccine Allocations,” org/2020/03/10/813922175/census-bureau-no-middle-eastern- U.S. News and World Report, March 9, 2021: https://www.usnews. or-north-african-check-box. com/news/best-states/articles/2021-03-09/q-a-how-alaska-is- 21 “The President’s Advisory Commission on Asian Americans & leading-in-covid-19-vaccination-efforts. Pacific Islanders: Advancing Economic Empowerment for Asian 32 Baltimore County Government, “Baltimore County Announces American and Pacific Islanders,” 2020,https://www.commerce. Innovative Efforts to Offer UBER Rides to Vaccine Clinics and Provide gov/sites/default/files/2021-03/RLA%20-%20PAC%20AAPI%20 Mobile Vaccines for Homebound,” February 26, 2021, https://www. Report%202020%20-%201.25.2021_DIGITAL.pdf. baltimorecountymd.gov/county-news/2021/02/26/baltimore- 22 Eugenia South, Twitter Post. February 14, 2021, 4:42pm. https:// county-announces-innovative-efforts-to-offer-uber-rides-to-vaccine- twitter.com/Eugenia_South/status/1361068415549657088. clinics-and-provide-mobile-vaccines-for-homebound. 33 23 “Data and Door Knocking: One City’s Push for Racial Equity “Meeting between Immigrant Health Advocates and the White in Vaccines,” Tradeoffs, March 4, 2021, https://tradeoffs. House Domestic Policy Council” (2021). org/2021/03/04/data-and-door-knocking-one-citys-push-for- 34 “How This New Yorker Created a Vaccine Appointment Website for racial-equity-in-vaccines/. $50,” The New York Times February 9, 2021, https://www.nytimes. 24 “Mayor Bowser Announces That Vaccination Appointments Will com/2021/02/09/nyregion/vaccine-website-appointment-nyc.html. Open for Child Care Providers and Charter and Independent School 35 Cat Ferguson, “What Went Wrong with America’s $44 Million Teachers Every Monday at Noon and 7 Pm,” DC Mayor Muriel Vaccine Data System?”, MIT Technology Review January 30, 2021, Bowser, February 7, 2021, https://coronavirus.dc.gov/release/ https://www.technologyreview.com/2021/01/30/1017086/cdc-44- mayor-bowser-announces-vaccination-appointments-will-open- million-vaccine-data-vams-problems/. child-care-providers-and-charter. 36 Tingling Dal, “How to End the Confusion of COVID-19 Vaccine 25 “Local Partnership Brings Vaccinations to Homebound Appointment Scheduling,” The Chicago Sun-Times, March 1, 2021, Cabarrus Residents,” Cabarrus County, March 4, 2021, https:// https://chicago.suntimes.com/2021/3/1/22307935/covid-19- cabarruscounty.us/news/local-partnership-brings-vaccinations-to- vaccine-appointment-scheduling-preregistration-tingling-dal-the- homebound-cabarrus-residents. conversation-op-ed. 26 “Ensuring Equity in COVID-19 Distribution: Engaging Federally 37 Cristina Silva, “‘It’s Life and Death’: Non-English Speakers Struggle Qualified Health Centers.” Health Resources and Services to Get COVID-19 Vaccine across US,” USA Today, February 22, 2021, Administration (HRSA), accessed April 3, 2021, https://www.hrsa. https://www.usatoday.com/story/news/nation/2021/02/22/ gov/coronavirus/health-center-program. covid-19-vaccine-registration-non-english-speakers-left- 27 COVID-19 Vaccination Plan for the Veterans Health Administration behind/4503655001/. (U.S. Department of Veterans Affairs, December 14, 2020). 38 Neelam Bohra, “Language Barriers Keep Asian Americans in Texas 28 Harmeet Kaur, “Tribal Health Providers Have Figured Out the Key from Vaccine Registration,” The Texas Tribune, March 19, 2021, to Covid-19 Vaccine Success. Here’s Their Secret,” CNN, February https://www.texastribune.org/2021/03/19/asian-americans-texas- 26, 2021, https://www.cnn.com/2021/02/09/us/tribal-health- language-vaccine/. providers-covid-vaccine-trnd/index.html. 39 Ese Olumhense, “Pa.’s Struggling COVID-19 Vaccine Rollout 29 Desiree Montilla, “It’s a relief: Thousands like up for COVID-19 Misses Latino Community, with No Targeted Help or Translations,” vaccine at VCU clinic,” NBC12, March 17, 2021. https://www.nbc12. Penn Live Patriot-News, February 9, 2021, https://www.pennlive. com/2021/03/17/its-relief-thousands-line-up-covid-vaccine-vsu- com/coronavirus/2021/02/lack-of-targeted-outreach-translated- clinic/. materials-leaves-latino-community-behind-as-pa-struggles-with- vaccine-rollout.html. 30 Miriam Jordan, “Thousands of Farmworkers are Prioritized 40 “CVS Health Builds on Community-Based Strategy to Address for Coronavirus Vaccine,” The New York Times, March 1, 2021,

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COVID-19 Vaccine Education and Equity,” PR Newswire, February org/10.1038/s41562-021-01056-1.\\uc0\\u8221{} {\\i{}Nature 19, 2021, https://www.prnewswire.com/news-releases/cvs-health- Human Behaviour} 5, no. 3 (March 2021). builds-on-community-based-strategy-to-address-covid-19-vaccine- 49 KFF, Hello Black America! With W. Kamau Bell & Black Health Care education-and-equity-301231414.html. Workers, Greater Than COVID, 2021, https://www.greaterthancovid. 41 Data and Door Knocking: One City’s Push for Racial Equity org/theconversation/. in Vaccines,” Tradeoffs, March 4, 2021, https://tradeoffs. 50 Center for Disease Control and Prevention (CDC), “CDC’s Social org/2021/03/04/data-and-door-knocking-one-citys-push-for- Vulnerability Index (SVI),” Agency for Toxic Substances and Disease racial-equity-in-vaccines/. Registry (ATSDR), September 15, 2020, https://www.atsdr.cdc.gov/ 42 Data and Door Knocking: One City’s Push for Racial Equity placeandhealth/svi/index.html. in Vaccines,” Tradeoffs, March 4, 2021, https://tradeoffs. 51 ABC7.com Staff, “Dodger Stadium to Halt COVID-19 Testing, Shift to org/2021/03/04/data-and-door-knocking-one-citys-push-for- Vaccination Site,” ABC7 Los Angeles, January 11, 2021, https://abc7. racial-equity-in-vaccines/. com/9547413/. 43 Michael Osterholm, “Osterholm Update LIVE (March 23, 2021),” 52 “See How the Vaccine Rollout Is Going in Your County and State,” Osterholm Update: COVID-19, March 23, 2021, https://www.cidrap. The New York Times, April 5, 2021, https://www.nytimes.com/ umn.edu/covid-19/podcasts-webinars/live-episode-3. interactive/2020/us/covid-19-vaccine-doses.html. 44 “TRANSCRIPT: March 22, 2021, Coronavirus Briefing Media,” State 53 Dylan Scott, “Fauci: 85 Percent of the US Needs to Get the Covid-19 of New Jersey, Governor Phil Murphy, March 22, 2021, https://www. Vaccine for ‘True Herd Immunity,’” Vox, December 15, 2020, https:// nj.gov/governor/news/news/562021/approved/20210322c.shtml. www.vox.com/coronavirus-covid19/2020/12/15/22176555/ 45 Martha Hostetter and Sarah Klein, Understanding and anthony-fauci-covid-19-vaccine-herd-immunity-goal. Ameliorating Medical Mistrust Among Black Americans. 54 “SARS-CoV-2 Variants of Concern,” Centers for Disease Control and Commonwealth Fund, January 14, 2021, https://www. Prevention, March 24, 2021, https://www.cdc.gov/coronavirus/2019- commonwealthfund.org/publications/newsletter-article/2021/jan/ ncov/cases-updates/variant-surveillance/variant-info.html#Concern. medical-mistrust-among-black-americans. 55 “COVID-19 and the Arts Part 2: Performing Arts and the Pandemic 46 “KFF COVID-19 Vaccine Monitor: February 2021,” Kaiser Family with Marin Alsop,” Public Health on Call, March 30, 2021, https:// Foundation, February 26, 2021, https://www.kff.org/coronavirus- html5-player.libsyn.com/embed/episode/id/18517148/height/550/ covid-19/poll-finding/kff-covid-19-vaccine-monitor-february-2021/. theme/custom/thumbnail/yes/direction/backward/no-cache/true/ 47 “KFF COVID-19 Vaccine Monitor: February 2021,” Kaiser Family render-playlist/yes/custom-color/f38443/destination_id/1899134. Foundation, February 26, 2021, https://www.kff.org/coronavirus- 56 Accelerating National Genomic Surveillance (The Rockefeller covid-19/poll-finding/kff-covid-19-vaccine-monitor-february-2021/. Foundation, n.d.), https://www.rockefellerfoundation.org/ 48 Sahil Loomba et al., “Measuring the Impact of COVID-19 Vaccine wp-content/uploads/2021/03/The-Rockefeller-Foundation_ Misinformation on Vaccination Intent in the UK and USA,” Nature Accelerating-National-Genomic-Surveillance.pdf. Human Behaviour 5, no. 3 (March 2021): 337—48, https://doi.

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This publication was written by: Kelly Murphy, Director of Early Childhood & Maternal Health, Families USA Sandra Wilkniss, Director of Complex Care Policy and Senior Fellow, Families USA

The following Families USA staff contributed to the preparation of this material (listed alphabetically): Melissa Burroughs, Associate Director for Strategic Partnerships Justin Charles, Digital Media Associate Katie Corrigan, Chief of Staff Nichole Edralin, Senior Manager, Design and Publications Rebecca Gordon, National Center for Coverage Innovation (NCCI) Intern 1225 New York Avenue NW, Suite 800 Lisa Holland, Senior Communications Manager Washington, DC 20005 Raashmi Krishnasamy, Health Equity Intern 202-628-3030 [email protected] Adina Marx, Communications Associate FamiliesUSA.org Lee Taylor-Penn, Senior Policy Analyst facebook / FamiliesUSA twitter / @FamiliesUSA

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